Provider Demographics
NPI:1306853965
Name:PRIMARY CARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:PRIMARY CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:NEPOMUCENO
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-581-7040
Mailing Address - Street 1:204 SHAVER DR
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8552
Mailing Address - Country:US
Mailing Address - Phone:423-581-7040
Mailing Address - Fax:423-581-9563
Practice Address - Street 1:204 SHAVER DR
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8552
Practice Address - Country:US
Practice Address - Phone:423-581-7040
Practice Address - Fax:423-581-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029081208000000X, 208000000X
TNAPN0000015927363LF0000X
TNAPN0000017666363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374269Medicaid
TN3374269Medicare PIN